Sunday, Sep 26 - Expo Hall Opening
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Monday,
Sep 27 - AWHONN's Block Party
Monday, September 27, 2010
: 2:00 PM
Title: Q Fever - Development of a Multidisciplinary Plan of Care for the Laboring Woman
Venetian
Discipline: Newborn (NB), Childbearing (CB)
Learning Objectives:
Submission Description:- Identify the significance of Q fever in pregnancy and 2 potential adverse effects on the fetus.
- Describe key components of a multidisciplinary plan of care when planning to deliver an infected patient.
- Discuss how you would adapt this case review to your own facility and/or local policy.
Background and Significance:
Q fever (coxiella burnetii) acquired during pregnancy is a serious disease that may result in abortions, premature deliveries, and stillbirths in infected women. Although rare, Q fever is highly infectious whereby a single organism can cause disease in humans. Developing a well rehearsed, multidisciplinary plan of care that speaks to resource allocation, airborne precautions, placenta disposition, and staff safety is monumental in ensuring positive outcomes for all parties involved.
Acute Q fever in pregnant women is significantly more asymptomatic than in other patients. Primary symptoms include high fever (104-105° F), myalgia, sore throat, non-productive cough, confusion, sweates, chills, nausea, vomiting, diarrhea, and chest pain. During pregnancy, Q fever may result in obstetrical complications, such as spontaneous abortion, intrauterine growth restriction, intrauterine fetal demise, oligohydramnios, and premature delivery. Because of the high rate of asymptomatic infection in pregnant women, it has been suggested that systemic testing for Q fever should be performed during pregnancy in areas where Q fever is prevalent and when a pregnant woman is febrile or has an abnormal delivery.
The diagnosis of acute and chronic Q fever is made through serological antibody testing. Treatment of the pregnant woman with Q fever infection is difficult because many of the drugs recommended are contraindicated during pregnancy (doxycyclone, fluoroquiinolones) (UpToDate, 2008). Current literature recommendations for treatment state co-trimoxazole for duration of pregnancy, specifically when infected during the first trimester (Raoult, Fenollar, & Stein, 2002). The efficacy of antibiotic thereapy is uncertain since most patients improve with or without treatement, and the outcome for the small number of patients developing chronic or life-threatening infection has not been radically altered by antibiotic treatment (Ludlam, Wreghitt, Thornton, Thomson, Bishop, Coomber and Cunniffe, 1997).
Purpose:
The purpose of this case review is to share insight into the delivery plan of care and preparation of staff personnel when a patient presents with Q fever infection in pregancy.
Design and Methods:
A well coordinated multidisciplinary plan of care was established to successfully labor and deliver a patient with Q fever diagnosis. It was imperative that all team members worked together to ensure optimal outcomes for the mother infant unit and hospital staff. Coordination of care was headed by Infectious Disease and the Maternal Fetal Medicine Department. A multidisciplinary prenatal patient care conference was conducted. Plan of care was tailored to the labor and delivery environment adapted from CDC and Infectious disease provider recommendations.
Findings and Implications:
As a result of the care conference, a detailed guideline was established and approved by the attendees to cover all potential labor and delivery scenarios. Further findings and implications will be presented in the completed paper presentation.
